Urethral valve

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Classification according to ICD-10
Q64.2 Urethral valve
ICD-10 online (WHO version 2019)

As a urethral valves (also urethral valves ), English posterior urethral valves , referred to sail-like protrusions in the urethra ( urethral ) positioned below the seed hill ( colliculus lie) and obstruct the flow of urine. In extreme cases, the urethra is completely blocked.

Only boys are affected by the malformation. It has an occurrence frequency of 1: 8000–1: 25000.

Effects

Due to the obstacle in the urethra, the urinary bladder has to build up increased pressure in order to empty the urine out of the bladder. If the valves are not very pronounced, there is only a thickened bladder wall. In the case of pronounced valves, urine can also flow back to the kidneys ( vesicorenal reflux ) with corresponding damage.

Prenatal kidney damage can lead to a reduced supply of amniotic fluid , which in turn leads to reduced lung growth and even lung hypoplasia . As a result, children with urethral valves are more likely to have miscarriages .

Diagnosis

Subvesical obstruction in the urethral valve
Unremarkable urethra , but bilateral reflux

Already prenatally, the large urinary bladder with a thickened bladder wall, possibly enlargements of the kidneys, the ureters or an insufficient amount of amniotic fluid are noticed in the ultrasound .

After the birth, the children are noticeable for a bad “stuttering” urine stream, in the ultrasound also for a large bladder, thickened bladder wall and enlargements of the kidneys and ureters. The direct detection of the valve is also possible by sonography. If the valves are less pronounced, the children can only attract attention later due to problems with drying out or urinary tract infections.

The diagnosis is made on the basis of the characteristic wall thickening with irregularities in the ultrasound and confirmed with a micturition cystourethrogram .

therapy

There are prenatal therapy attempts in which either an attempt is made to destroy the valve or to relieve the urinary bladder by a minimally invasive catheter until the due date. This procedure has been used and further developed at the German Center for Fetal Surgery & Minimally Invasive Therapy for several years. The procedure is usually performed between the 14th and 30th week of pregnancy.

The urethral valves are blown endoscopically or slit (with a knife, an electric hook or) with a laser. Depending on the severity, it may first be necessary to drain the bladder through a catheter. Several slots may be necessary.

forecast

The prognosis depends on the extent of the obstruction and the resulting kidney damage: If changes are recognizable before the 24th week of pregnancy, or if the kidneys are altered in their echogenicity or if they have cysts, there is an increased risk that dialysis will be required in childhood or adolescence becomes. Further complications are problems with drying out, urinary incontinence , urinary tract infections, infections of the epididymis .

literature

  • M. Bettex, N. Genton, M. Stockmann (Eds.): Pediatric Surgery. Diagnostics, indication, therapy, prognosis. 2nd edition, Thieme 1982
  • JP Kuhn, TL Slovis, JO Haller (Eds.): Caffey's Pediatric Diagnostic Imaging . 10th edition, Mosby 2004. ISBN 0-323-01109-8 .

Individual evidence

  1. ↑ www.emedicine.com
  2. ^ V. Hofmann, KH Deeg, PF Hoyer: Ultrasound diagnostics in paediatrics and pediatric surgery. Textbook and atlas. Thieme 2005, ISBN 3-13-100953-5 .
  3. ↑ UMM: Urinary flow disorders: University Hospital Mannheim. Retrieved July 26, 2018 .

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